中老年有移位股骨颈骨折全髋关节置换术和骨折内固定术临床比较

COMPARISON OF COXA REPLACEMENT AND INTERNAL FIXATION OF FRACTURE FOR MIDDLE-AGED DISPLACED FRACTURE OF NECK OF FEMUR

目的比较全髋关节置换术与骨折内固定术治疗中老年股骨颈骨折的疗效.方法将1995～2001年作者收治的112例50～70岁有移位的股骨颈骨折患者分为2组,A组为内固定术治疗62例,B组为全髋关节置换术治疗50例.随访36～75个月,术后1、3、5年功能评估.结果全髋关节置换组在手术时间,术后早期下床活动等方面具有一定的优越性,2组在合并症的发生率、住院时间和伤后入院手术时间比较,差异不显著(P＞0.05);而并发症发生率(A组35.5%,B组10%)、扶双拐下地活动时间(A组90 d,B组14～21 d)及功能评价(术后3～5年B组优于A组),有显著差异(P＜0.05).结论全髓关节置换术治疗老年股骨颈骨折的优点为:减少股骨颈骨折不愈合及股骨头坏死问题;早期下床活动,短期内恢复患者的正常生活能力;但存在假体磨损,假体松动等远期并发症.

Objective To compare the curative effect of coxa replacement and internal fixation of fracture for middle-aged displaced fracture of neck of femur. Methods 112 cases of fracture of neck of femur from 50 years to 70 years were treated in the hospital between 1995 and 2001. 62 cases in Group A were treated with internal fixation of fracture, 50 cases in Group B were treated with articulation coxa replacement. The follow-up time was from 36 months to 75 months. The hospitalized condition and the function after the operation for 1 year, 3 years and 5 years were assessed. Results Group B had a little advantage in the operational time and forepart movement after the operation. There was no conspicuous meaning in complication incidence and hospitalized time （ P〉0.05） ; But the complication rate（Group A was But there was conspicuous difference between Group A and B （ P 〈0.05） ： the complication rate （Group A 35.5% ; Group B 10% ）, the time of using the stick to move （Group A 90 days; Group B 14 days to 21 days） and function assessment （Group B was better than Group A in the long run） ,Conclusions The advantages of coxa replacement for middle-aged displaced fracture of neck of femur has two advantages： It could avoid the fracture of neck of femur disunion and femur-caput putrescence and the patient could recover the normal living ability in short times. But there was long-range complication include prosthesis attrition, prosthesis looseness etc. So, for the middle-aged displaced fracture of neck of femur, the therapy should be used according to the age, the intensity of work, the move demand and the personal condition.